Assessment of the relationship between the return to work and the severity of work-related upper limb injuries using the whole person impairment / 中华创伤杂志(英文版)

PURPOSE@#Upper limb disorders are one of the most common and important types of occupational injuries. Besides, identifying the factors influencing return to work following these injuries is essential to reduce the dimensions of the problem. In this study, we investigated the return to work and associated factors following occupational injuries leading to upper limb impairment.@*METHODS@#In this retrospective cohort study, the rate of return to work and associated factors were assessed in 256 workers with work-related upper limb injury referred to a teaching hospital from March 2011 to December 2018. The inclusion criterion was a history of occupational injury resulting in upper limb impairment, and exclusion criteria included the presence of simultaneous impairment in other organs, congenital or non-occupational limb defects as well as patients with incomplete information in their medical records. Individuals' records, including age at the time of injury, gender, date of injury, marital status, education, level of amputation and injury, whole person impairment (WPI) and physiotherapy (prescribed by the physician) were reviewed. The WPI was calculated to assess the extent of the injury. All analyzes were performed by SPSS version 25.0.@*RESULT@#The rate of return to work was 54.3%, in which 51.8% for the same job and 48.2% for a new job. The main factors associated with non-return to work were more days off work (p = 0.001), higher injury severity (p = 0.001), and dominant hand injury (p = 0.034).@*CONCLUSION@#The number of days off work, the WPI, and dominant hand injury are the most important determinant in returning to work. In addition, increased job satisfaction and support from co-workers and employers are work-related factors that can lead to an increased return to work.

Manejo quirúrgico de heridas por mordeduras de perro en pacientes pediátricos: nuestra experiencia en 8 años / Surgical management of dog bite wounds in pediatric patients: our experience in 8 years

Introducción. Hasta un 90% de las mordeduras de animales son producidas por perros. Los niños son la población más vulnerable frente a las mordeduras ya que suelen afectar una mayor proporción de superficie corporal. Objetivo. Analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. Métodos. Estudio observacional, descriptivo, retrospectivo de un período de 8 años, que incluyó a todos los pacientes de 0 a 18 años con diagnóstico de mordedura de perro. Resultados. Se incluyeron 183 pacientes con diagnóstico de mordedura de perro. El promedio de edad fue de 6,1 años, y el grupo etario más afectado fue el de los niños de 3 a 5 años (38,3%). El tratamiento quirúrgico fue dividido en pacientes que requirieron rafia por planos (84,6%), colgajos (11,4%), injertos (3,4%) y puntos de aproximación (1%). Se reportaron 8 pacientes con complicaciones (4,4%). Conclusión. Los niños de 3 a 5 años son los más afectados por mordeduras de perro y la zona de cabeza y cuello es la más común. Un porcentaje importante de pacientes requirieron colgajos e injertos con buenos resultados.

Introduction. Up to 90% of animal bites are produced by dogs. Children are the most vulnerable population because bites tend to affect greater body surface area. Outcome. Analyze dog bites cases and their impact on our environment. Methods. An observational, descriptive, retrospective study during an 8 year period was carried out, which included all patients from 0 to 18 years with a diagnosis of dog bite. Results. A total of 183 patients with a diagnosis of dog bite were found. The average age was 6.1 years, and the age group most affected was children from 3 to 5 years old (38.3%). Surgical treatment was divided into: patients who required suture by planes (84.6%), flaps (11.4%) and grafts (3.4%) and approximation stitches (1%). Complications were reported in 8 patients (4.4%). Conclusion. Children from 3 to 5 years old are the most affected by dog bites, the head and neck area is the most common. A significant percentage of patients required flaps and grafts with good results.

Aneurisma venoso postraumático en extremidades superiores. Presentación de dos casos / Post-traumatic venous aneurysm in the upper limbs. Case report on two patients / Aneurisma venoso pós-traumático nos membros superiores. Apresentação de dois casos

RESUMEN Los aneurismas venosos, en especial de la extremidad superior, son malformaciones vasculares de baja frecuencia. Se presentó el manejo de dos pacientes del sexo femenino atendidas en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente "Dr. Agostinho Neto" de la provincia Guantánamo, Cuba, a las que se les diagnosticaron aneurismas en diferentes segmentos del sistema venoso superficial de la extremidad superior, los que se resecaron quirúrgicamente y se les confirmó el diagnóstico mediante biopsia.

ABSTRACT Venous aneurysms, especially the ones located in the upper limbs, are vascular malformations with low incidence in the population. Two cases of venous aneurisms on female patients showed up at the Angiology and Vascular Surgery services at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo, Cuba. Aneurism diagnosis was confirmed through biopsy. They were located in different segments of the superficial venous system of the upper limbs, and were surgically resected.

RESUMO Os aneurismas venosos, principalmente de membro superior, são malformações vasculares de baixa frequência. Foi apresentada a gestão de duas pacientes do sexo feminino atendidas no Serviço de Angiologia e Cirurgia Vascular do Hospital General Docente "Dr. Agostinho Neto" da província de Guantánamo, Cuba, que foram diagnosticados com aneurismas em diferentes segmentos do sistema venoso superficial do membro superior, os quais foram ressecados cirurgicamente e o diagnóstico foi confirmado por biópsia.

O tempo e maneira de utilização do celular podem predispor à lesões musculoesqueléticas: estudo caso-controle / Time and characteristics of cell phone usage may predispose musculoskeletal injuries: case-control study

Objetivo:avaliar e comparar o tempo de utilização, postura e o manuseio do celular entre voluntários com e sem dor na região dos membros superiores ou da coluna cervical. Métodos:Este estudo possui um delineamento observacional transversal. Foram avaliados o tempo e finalidade, a maneira e postura de utilização do celular utilizando questionários com questões abertas de 24 participantes com dor na região da coluna cervical ou membro superior e 24 do grupo controle, que não apresen-tavam dor, com gênero e idade pareados entre os grupos. As comparações entre grupos foram realizadas por meio do Teste T de student para as variáveis contínuas e para as categóricas o Qui quadrado. Resultados: o grupo com dor apresentou maior utilização do celular sem apoio, tempo para digitar, internet e chamada do que o grupo controle (p<0,05). Não houve diferen-ça entre os grupos para a utilização da agenda, ouvir músicas e jogar no celular e tipo de manuseio (p>0,05). Conclusão:O tempo de utilização do celular para digitar, usar a internet e chamadas, a maneira de digitar e a postura sem apoio foram maiores em voluntários com dor, sugerindo que esses fatores podem influenciar no desenvolvimento de dor musculoesque-léticas na região de cervical e de membros superiores. (AU)

Objective: To evaluate and compare the time of cell phone use among volunteers with and without pain in the upper limbs and cervical spine area. Methods:This is an observational cross-sectional study. Questionnaires about cell phone usage were applied in 24 participants reporting pain in the cervical spine or upper limb and 24 participants without pain, aged 20 to 32 years old. The exclusion criteria were history of previous surgery, trauma and orthopedic injury or usage of upper limbs immobilization over the past six months. The comparisons between groups were performed using the t student test for continuous data, and Chi-square test for categorical data. Results: The pain group showed greater use of cell phone in a sitting position and without any support, while the control group used it in a sitting position with support (p< 0.05). Cell phone usage time for typing messages, browsing the web and making phone calls were greater in the pain group than in the control group (p< 0.05). There was no difference between the groups for using the calendar, listening to music and playing games on mobile (p> 0.05). Conclusion: The time using the cell phone to type, use the internet and make calls, as well as the posture adopted and the usual handling of these devices are different between groups, suggesting that these factors may influence the musculoskeletal pain in the cervical region and upper limbs development.(AU)

Un caso de amiloidosis AL / A case report of AL amyloidosis

Antecedentes: la amiloidosis es una enfermedad sistémica que resulta del depósito de proteínas mal plegadas; en la amiloidosis de cadena ligera de la inmunoglobulina (AL), las fibrillas están compuestas de fragmentos de cadenas ligeras monoclonales. En la Argentina, la densidad de incidencia de amiloidosis AL es 4,54 cada millón de personas/año. Caso: paciente femenina de 71 años que consulta por dolor neural localizado en miembro superior izquierdo, asociado a edemas en ambos miembros inferiores y disnea de esfuerzo, pérdida de peso, constipación y macroglosia. Al examen físico presenta tensión arterial de 100/60 mm Hg; está afebril, saturando 98% de aire ambiente; peso de 46 kg y un índice de masa corporal de 18,9. Se constatan cadenas livianas libres Kappa: 5,8 mg/L, Lambda: 430 mg/L y con relación K/L: 0,13 mg/L y un ProBNP de 1686 pg/mL. La biopsia de grasa abdominal informó depósitos de amiloide, tinción de rojo Congo positivo. Resonancia magnética (RM) de corazón con contraste (gadolinio), compatible con amiloidosis cardíaca. La tomografía computarizada (TC) de tórax demostró un área de consolidación en lóbulo superior del pulmón derecho, rojo Congo positivo focal. Ante el diagnóstico de amiloidosis AL se realiza tratamiento con CYBORD. Se consolidó el tratamiento con un trasplante autólogo de médula ósea. Discusión: la afectación cardíaca es la principal causa de morbilidad y mortalidad dentro de la amiloidosis. (AU)

Background: amyloidosis is a systemic disease resulting from the deposition of misfolding proteins, in immunoglobulin light chain amyloidosis (AL) fibrils are composed of fragments of monoclonal light chains. In Argentina the incidence density of AL amyloidosis is 4.54 per million people year. Case: a 71-year-old female patient who consults for neural pain located in the left upper limb, associated with edemas in both lower limbs and exertional dyspnea, weight loss, constipation and macroglossia. On physical examination she had blood pressure of 100/60 mmHg, afebrile, saturating 98% of ambient air, weight of 46 kg and body mass index of 18.9. The peripheral blood laboratory has Kappa free light chains: 5.8 mg/L, Lambda: 430 mg/L with K L ratio: 0.13 mg/L and a ProBNP of 1686 pg/mL. Abdominal fat biopsy reports positive Congo red staining. Cardiac magnetic resonance with contrast (gadolinium) has been performed and result compatible with cardiac amyloidosis. Chest CT showed an area of consolidation in the upper lobe of the right lung; positive congo red. With the diagnosis of AL amyloidosis she was treated with CYBORD. Autologous stem cell transplantation was performed. Discussion: cardiac involvement is the main cause of morbidity and mortality by amyloidosis. (AU)

Transposition of latissimus dorsi to the elbow inorder to elbow make extention and homeros coverage

Because of some reasons local flaps are not suitable in the cases with upper extremity injuries, lattismus dorsi flaps are recommended in these cases. We present a twenty eight years old male with upper extremity trauma with type 3C left homerus fracture and destruction of triceps. Reconstruction made using lattismus dorsi flap and in a two month follow up we find a 30° Extention lag comparing to the right elbow while the patient had cosmetically satisfaction

Injuries prevalence in elite male artistic gymnasts / Prevalência de lesões na ginástica artística masculina de alto rendimento

Abstract The purpose of this study was to investigate the injuries prevalence in men elite artistic gymnasts. Twenty Brazilian senior gymnasts, aged 23.1 ± 6.5 years, 13.9 ± 5.0 years of practice and 36.5 ± 4.7 hours per week training, participated in this study. The athletes answered a morbidity questionnaire, formulated according to studies from the literature, for information on the injuries’ characteristics and circumstances. Information about the injury circumstances (gymnastic apparatus, overload training and physical exercises), the anatomic site injured, the affect biological tissue and the return to training after injury treatment were evaluated. Data were analyzed by descriptive statistics, absolute and relative frequencies. The training overload, and floor, pommel horse and vault were the events that presented higher injuries frequency. In relation to anatomic site, ankle, hands/fingers and shoulder were the most cited regions. The ligament, bone and articular capsule were the most affected biological tissues. In relation to gymnasts’ return to their sports activities, 56% of them reported a better condition at return, 33% reported to have returned at the same fitness level and 10% indicated that they were in a worse condition when they returned to the sports activities. The men’s artistic gymnastics injuries are related to the mechanical demands of this sport. The analysis of risk factors helps in understanding the injuries mechanisms in gymnastics, and provides relevant information that can assist in effective prevention strategies.

Resumo A proposta deste estudo foi investigar a prevalência de lesões na ginástica artística masculina de alto rendimento. Vinte ginastas brasileiros da categoria adulta, com 23,1 ± 6,5 anos, 13,9 ± 5,0 anos de prá- tica no esporte e 36,5 ± 4,7 horas de treino semanais, participaram do estudo. Os atletas responderam o questionário de lesões referidas, formulado a partir de estudos da literatura, para obter informações sobre as características e circunstâncias das lesões. Foram considerados dados sobre o aparelho ou evento do treinamento em que ocorreu a lesão, o local anatômico lesionado, o tecido biológico afetado e o retorno às atividades após a lesão. Os dados foram avaliados por meio de estatística descritiva, a partir das frequências absolutas e relativas. A sobrecarga de treinamento e os aparelhos solo, cavalo com alças e salto sobre a mesa foram os eventos com maior frequência de lesões. Em relação ao local anatômico, tornozelo, mãos/dedos e ombro foram as regiões mais citadas. Os tecidos ligamentares e ósseo, bem como a cápsula articular foram os tecidos biológicos mais afetados. Em relação ao retorno às atividades, 56% relataram melhora, 33% reportaram retorno ao mesmo nível prévio à lesão e 10% relataram piora do desempenho após retorno às atividades. As lesões na ginástica artística masculina estão associadas às demandas mecânicas do esporte. A análise dos fatores de risco contribui no entendimento dos mecanismos das lesões na ginástica, bem como pode auxiliar em estratégias efetivas de prevenção.

Cerebral palsy in adult patients: constraint-induced movement therapy is effective to reverse the nonuse of the affected upper limb / A eficácia da terapia por contensão induzida em pacientes adultos com paralisia cerebral

ABSTRACT Objective To determine if the original protocol of Constraint-Induced Movement Therapy (CIMT), is adequate to reverse the nonuse of the affected upper limb (AUL) in patients with Cerebral Palsy (CP) in adulthood. Method The study included 10 patients diagnosed with CP hemiparesis had attended the adult protocol CIMT, from January/August 2009/2014. Results Average age 24.6 (SD 9.44); MAL average pretreatment How Often (HO) = 0.72 and How Well (HW) = 0.68 and post-treatment HO = 3.77 and HW = 3.60 (p ≤ 0.001) and pretreatment WMFT average = 21.03 and post-treatment average = 18.91 (p = 0.350). Conclusion The constraint-induced movement therapy is effective to reverse the nonuse learn of the AUL in adult patients with CP.

RESUMO Objetivo Determinar se o protocolo original da Terapia por Contensão Induzida (TCI), é adequado para reverter o não uso do membro superior afetado (MSA) em pacientes com Paralisia Cerebral (PC) na fase adulta. Método Foram incluídos no estudo 10 pacientes com diagnóstico de PC hemiparéticos que haviam realizado o protocolo adulto da TCI, no período de janeiro/2009 a agosto/2014. Resultados Média de idade 24,6 (DP 9,44); MAL média pré-tratamento Quantidade (QT) = 0,72 e Qualidade (QL) = 0,68 e no pós-tratamento QT = 3,77 e QL = 3,60 (p ≤ 0,001) e WMFT média pré-tratamento = 21,03 e média pós-tratamento = 18,91 (p = 0,350). Conclusão A terapia por contensão induzida é eficaz para reverter o não uso do MSA em pacientes adultos com PC.

Reconstruções complexas de membros superiores e inferiores com retalhos de fluxo reverso: uma série de 32 casos / Complex reconstruction of the upper and lower limbs by using reverse-flow flaps: a series of 32 cases

Introdução: A reconstrução de partes moles após perdas de substância do terço distal dos membros superiores e inferiores, principalmente quando associada à exposição de estruturas nobres (osso, tendão, nervos ou vasos sanguíneos), continua a desafiar a cirurgia plástica. Os retalhos fasciocutâneos de fluxo reverso são uma eficiente opção cirúrgica na cobertura de lesões pequenas e médias nesta localização. Método: Foi realizado um estudo clínico retrospectivo, no período de janeiro de 2013 a dezembro de 2014, de uma série de 32 casos de traumas complexos em membros superiores e inferiores. Resultados: Foram realizados 24 retalhos de fluxo reverso nos membros inferiores e 8 nos membros superiores, observando-se uma cobertura eficaz dos defeitos. Conclusão: Os retalhos de fluxo reverso são confiáveis e apresentam arcos de rotação que permitem a cobertura de lesões diversas no terço distal de membros superiores e inferiores.

Introduction: Reconstruction of the soft tissues after loss of substance in the distal third of the upper and lower limbs, in particular when associated with the exposure of noble structures (bone, tendon, nerves, or blood vessels), remains a challenge in plastic surgery. Fasciocutaneous reverse flow flaps are an efficient surgical option for covering small and medium lesions in this location. Method: A retrospective clinical study was performed on a series of 32 cases of complex trauma of the upper and lower limbs treated between January 2013 and December 2014. Results: A total of 24 reverse-flow flaps were performed in the lower limbs and eight in the upper limbs, resulting in efficient coverage of the defects. Conclusion: Reverse-flow flaps are reliable and present rotation arcs that allow coverage of a variety of lesions in the distal third of the upper and lower limbs.

Crutch-related acute arterial thrombosis in upper limb: case report / Oclusão arterial aguda de membro superior associada à utilização de muleta: relato de caso

Case report of an acute arterial obstruction in the upper limb secondary to thrombosis of the axillary artery caused by chronic use of crutches. The authors make a brief review of the literature and discuss it in relation to the present case.

Relato de caso de obstrução arterial aguda do membro superior por trombose da artéria axilar secundária ao uso crônico de muleta. Os autores fazem uma breve revisão da literatura, discutindo o presente caso.

Application of needle electromyography and nerve conduction study in forensic appraisal / 法医学杂志

OBJECTIVE@#To explore the application value of needle electromyography (EMG) and nerve conduction study (NCS) in the forensic appraisal; to provide scientific basis for establishing normative and unified assessment methods of the peripheral nerve study in forensic medicine.@*METHODS@#One hundred and sixty-four samples with injured peripheral nerve (injury group) and 138 samples with normal peripheral nerve (control group) were collected and tested with methods of EMG and NCS respectively. The relevance rate of two methods were compared and statistical analysis was performed.@*RESULTS@#In the injury group, there was no statistical difference on the relevance rate between the application of EMG and that of NCS (P > 0.05). In the control group, there was no statistical difference on the negative rate between the two methods (P > 0.05). The false negative rate of the injury group and the false positive rate of the control group were both 0% when using the two methods together.@*CONCLUSION@#When the injured peripheral nerve in forensic appraisal is in doubt, application of both EMG and NCS could disclose truth from falsehood. The accuracy and credibility of identification results could be enhanced.

Maxillofacial and associated fractures of the skeleton - a study

The purpose of the present study was to evaluate the incidence of associated skeleton fractures with maxillofacial fractures and to list age gender and bone involved with poly trauma patients. The study is first of its kind in the region and will help to develop a better poly trauma management team. A Descriptive study was carried out in Oral and Maxillofacial Surgery Department of Khyber College of Dentistry, Peshawar, Pakistan for a period of one year i.e., from 20[th] June 2009 to 19[th] June 2010. All the patients presenting with maxillofacial injures and associated fractures of the skeleton were included in this study. Age, gender distribution, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. A total of 505 patients reported to oral and maxillofacial surgery unit of Khyber College of Dentistry, Peshawar, and amongst them 54 [10.6%] had associated fractures of the rest of the skeleton of the body. The most commonly involved bone was mandible [67%] followed by zygomatic complex fratures i.e. 15% in these patients. 50% of the fractures resulted because of Road Traffic Accidents. Upper limb fractures were the most common bone fractures associated with maxillofacial trauma i.e., 53.25% of the cases

Factores asociados a desórdenes musculoesqueléticos de miembro superior en ordeñadoras manuales, Cajamarca 2009 - 2010 / Factors associated with musculoskeletal disorders of the upper limb in the manual milkmaids of Cajamarca, Cajamarca 2009-2010

Objetivo: Determinar los factores asociados a desórdenes musculoesqueléticos de miembro superior en las ordeñadoras manuales de Cajamarca. Metodología: Se realizó un estudio cuantitativo, descriptivo de corte transversal en una muestra de 102 mujeres ordeñadoras que residen en la provincia de Cajamarca. Se aplicó una encuesta para obtener datos demográficos, datos laborales y valores antropométricos; la evaluación clínica se basó en los criterios diagnósticos para desórdenes de miembro superior del Instituto de Salud Ocupacional de la Universidad de Birmingham (Inglaterra) publicado en el Atlas de Reumatología Clínica de la Universidad de Querétaro (México). Se hizo un análisis descriptivo univariado de las prevalencias y las proporciones entre las diferentes variables fueron evaluadas por medio de la prueba de Chi cuadrado, con un nivel de significancia de 0.05. Resultados: En este estudio se evidencia que 33,3 por ciento presentan algún desorden musculoesquelético (DME) de miembro superior, presentándose con más frecuencia el síndrome del túnel carpiano 24,5 por ciento, epicondilitis lateral 9,8 por ciento y tendinitis bicipital 8,8 por ciento. En miembro superior derecho 57.7 por ciento, en miembro superior izquierdo 33.8 por ciento y en algunos casos ambos miembros superiores 8.5 por ciento. Se evidencia la asociación con edad y factores laborales como tipo de ordeño, permanencia en el trabajo y postura. Conclusión: El ordeño manual es un factor relacionado con el desarrollo de DME de miembro superior

Objective: To determine the factors associated with musculoskeletal disorders of the upper limb in the manual milkmaids of Cajamarca. Methodology: A quantitative and descriptive of cross sectional study was conducted in a sample of 102 milkmaids that reside in the province of Cajamarca. A survey to obtain demographic and employee data, and anthropometric values was performed. The clinical evaluation was based on the diagnostic criteria for disorders of the upper limb of the Institute of Occupational Health of the University of Birmingham (England) published in the Atlas of Clinic Rheumatology at the University of Queretaro (Mexico). A descriptive univariate analysis of the prevalences was done and the proportions between the different variables were evaluated by the Chisquare test, with a significance level of 0.05. Results: This study showed that 33.3 per cent presented some musculoskeletal disorder (MED) of the upper limb, appearing more frequently the carpal tunnel syndrome 24.5 per cent, lateral epicondylitis 9.8 per cent and bicipital tendinitis 8.8 per cent. In right upper limb 57.7 per cent, in left upper limb 33.8 per cent and in some cases both upper limbs 8.5 per cent. There is evidence of association with age and occupational factors such as type of ordered, stay in a job and position. Conclusion: The manual ordered is a factor related to the development of MED of upper limb

Trauma vascular de extremidad superior: manejo en la etapa aguda / Vascular trauma of an upper extremity: management in the acute stage

El trauma vascular es una situación de emergencia a la cual podemos vernos enfrentados en la unidad de urgencia, la cual puede causar la muerte del paciente de no realizar un manejo oportuno. Las extremidades representan el principal sitio de lesión en la población civil y de éstas alrededor del 30 por ciento afectan la extremidad superior. La principal etiología es el trauma penetrante, específicamente por arma de fuego, existiendo además un aumento alarmante de las lesiones iatrogénicas. El cirujano de urgencia debe tener los conocimientos teóricos y prácticos que le permitan un adecuado diagnóstico, y manejo en la etapa aguda, siendo el objetivo fundamental la sobrevida del paciente y luego el salvataje de la extremidad. La indicación actual ante la presencia de signos duros es la exploración quirúrgica clásica, existiendo algunos pacientes que podrían ser resueltos por cirugía endovascular, específicamente pacientes estables hemodinámicamente con lesiones de la arteria axilar y braquial proximal. En el presente artículo se exponen las consideraciones básicas en el manejo de emergencia del paciente con trauma vascular de extremidad superior.

The vascular trauma is an emergency situation at which we may be confronted in the emergency unit. This may cause the patient’s death if not made a timely management. The limbs represent the main site of injury in civilian population. 30 percent affect the upper extremity. The main etiology is penetrating trauma, specifically gunshot. There is also an alarming increase of iatrogenic injuries. The emergency surgeon should have an appropriate theoretical and practical knowledge to allow a proper diagnosis, and management in the acute stage. The main objective is to keep the patient alive and then the rescue of the limb. The current indication in the presence of objective signs is the classic surgical exploration, and there are some patients who could be resolved by endovascular surgery, specifically hemodynamically stable patients with injuries of the proximal brachial and axillary artery. This article presents the basic considerations in the emergency management of patients with upper extremity vascular trauma.

Salvataje de miembro superior en pacientes pediátrico con sarcoma de Ewing: a propósito de un caso / Upper limb salvage in pediatric patients with Ewing sarcoma: report of a case

El sarcoma de Ewing es un tumor maligno perteneciente al grupo de tumores neuroectodérmicos primitivos. Se conoce poco acerca de los factores etiológicos y generalmente afecta la diáfisis de hueso largo y la pelvis. Rara vez puede localizarse extraesqueléticamente. La tendencia es a presentarse en gente joven durante la fase de mayor crecimiento. Representa el 1 por ciento de los tumores en la infancia y es el segundo tumor maligno primario del hueso en la niñez y adolescencia, con un pico de edad entre 5 y 13 años. En el presente se reporta el caso de un paciente masculino de 10 años de edad, con diagnóstico de Sarcoma de Ewing Primario en Húmero Izquierdo Estadio III. Fue tratado con esquema de Quimioterapia y Radioterapia; en vista de su buena evolución se ofreció Cirugía Reconstructiva como medida de salvataje del miembro superior. Se realizó resección del húmero con márgenes quirúrgicos amplios y se colocó aloinjerto óseo de tibia, estabilizándose con material de osteosíntesis proximal y distalmente. Como resultado se observó remodelación ósea y osteointegración completa del injerto, así como rangos de movilidad aceptables en el primer año de evolución. Los procedimientos quirúrgicos para la reconstrucción de los miembros, después de la extirpación del Sarcoma de Ewing Primario, constituyen una alternativa en un intento por evitar la amputación.

The Sarcoma of Ewing is a malignant tumor pertaining to the gruop of primitive neuroectodermal tumors. Little is known about the etiologic factors and it generally affects the diaphysis of long bones and pelvis. Rarely it can be located extraskeletally. The tendency is to appear in young people during the phase of greater growth. It represents 1 percent of the tumors in the childhood and is the second primary malignant tumor of the bone in the childhood and adolescence, with a tip of age between 5 and 13 years. In the present work the case of a masculine patient of 10 years of age is resported, with diagnosis of Sarcoma of Primary Ewing in Left Chimney Stage III. It was dealed with schemes Chemotherapy and X-ray; in view of its good evolution Reconstructive Surgery was offered like measurement of salvataje of the member superior. Resection of the chimmey with ample surgical margins was realised and aloinjerto bony of tibia was placed distate, becoming stabilized with material of proximal osteosynthesisand as result were observed bony remodeling and complete osseointegration of the graft, as well as acceptable ranks of mobility in the first yeras of evolution. The surgical procedures for the reconstruction of the members, after the extirpation of the Sarcoma of Primary Ewing, constitute an alternative in an attempt to avoid the amputation.

Experiencia del bloqueo paravertebral en sensibilización espinal segmentaria / Paraspinous block experience in spinal segmental sensitization

La Sensibilización Espinal Segmentaria (SES) corresponde a un estado hiperactivo de un segmento espinal en reacción a un foco irritativo, el cual bombardea constantemente el ganglio sensorial con estímulos. Esto se traduce en dolor espontáneo, hiperalgesia y adolinia. El Bloqueo Paraespinoso (BPE) ayudaría a la desensibilización gradual del segmento espinal comprometido. Objetivo: Mostrar manifestaciones de la SES y los efectos de Bloqueo Paraespinal en pacientes con dolor crónico de extremidad superior atendidos en el Servicio de Medicina Física y Rehabilitación del HCUCH entre abril - agosto 2008. Material y Métodos: Estudio descriptivo - retrospectivo de pacientes que consultan por dolor crónico de extremidad superior, que presentaron signos de SES en atención ambulatoria del Servicio de Medicina Física y Rehabilitación del HCUCH. Se evaluó características demográficas y clínicas, y respuestas tras BPE. Resultados: Once pacientes presentaron signos de SES. El 100 por ciento fue de sexo femenino, con una mediana edad de 44 años. El 63,6 por ciento presentó Epicondilitis como diagnóstico inicial, seguido de Lesión de MAnguito Rotator (36 por ciento) y el 36 por ciento presentó mas de una patología. El EVA inicial fue en promedio de 8,9. El territorio afectado más frecuente fue C6 - C7 (36 por ciento). Tras el BPE, el dolor en reposo disminuye a un EVA promedio de 2,8 (diminución de un 68,3 por ciento). Incidentalmente, se observó ganancia en los rangos articulares de los segmentos comprometidos. Discusión: La búsqueda y tratamiento de la SES mediante el BPE puede ser una herramienta útil en el manejo de pacientes con dolor crónico musculoesquelético.

Introduction: Spinal Segmental Sensitization (SSS) relates to an hyperactive state of one spinal segment reacting to a source of irritation that is constantly stimulating the dorsal ganglion. This translates into spontaneous pain, hyperalgesia and allodinia. The Paraspinus Block (PB) technique would prove useful to desensitize the reacting segment. Objetive: To show SSS manifestations and the effects of Paraspinus Block in patients with chronic pain in upper limbs treated at Hospital Clinico Universidad de Chile Physical and Rehab Med Center from April through August 2008. Materials and Method: Descriptive and retrospective study of Physical and Rehab Med Center outpatients with upper limb chronic pain showing signs of SSS. Demographic and clinical information was evaluated as well as response to PB treatment. Results: Eleven patients showed signs of SSS of which 100 percent were female in their mid forties. 63.6 percent were initially diagnosed with Epycondilitis while 36 percent with Rotator Cuff Tear and 36 percent with more than one disease. The initial average VAS was 8.9. The most affected area was C6 - C7 (36 percent). After PBE pain while resting is reduced to an average VAS of 2.8 (a 68.3 percent reduction). We also observed a gain in irritated segments. Discussion: The search and treatment of SSS using PBE could be a useful tool for pain management in patients with musculoskeletal chronic pain.

Artropatía neuropática en miembro superior izquierdo por siringomielia: reporte de un caso / Neuropathic arthropathy in the left upper limb for syringomyelia: a case report

Paciente masculino de 66 años, quien cursa con signos de Celsus, limitación funcional en hombro izquierdo sin dolor 3 meses de evolución; sin antecedente traumático previo. Presenta hipoestesias a nivel de C4, y zona de anestesia en C5, C6 fuerza muscular V/V flexión 120º, extensión 40º hombro izquierdo. En rayos X reabsorción total de la cabeza del húmero izquierdo, con cambios degenerativos a nivel del codo ipsilateral, y columna cervical con cambios artrosicos; Resonancia magnética: se observa siringomielia del cordón medular cervical hasta porción torácica, cambios degenerativos y compromiso foraminal bilateral desde C2-C3 hasta C6-C7. Este caso representa una artropatía neuropática de hombro y codo secundaria a siringomielia; la cual por ser una patología poco común pasa desapercibida siendo de difícil diagnóstico para ortopedistas y traumatólogos jóvenes en formación con las consecuentes interrogantes de su manejo terapéutico.